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N626 Remark Code: E/M Not Payable With Chiropractic

N626 means the payer will not pay a new or established patient evaluation and management (E/M) service billed with chiropractic care codes on the same claim or day. The payer considers the evaluation part of the chiropractic service.

Quick facts

Code
N626 (RARC N626)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The E/M is treated as included in the chiropractic service. The provider writes it off; the patient is not billed.
Official description
New or established patient E/M codes are not payable with chiropractic care codes.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N626 means

Chiropractic manipulation codes include a brief assessment before the treatment. When an office visit (E/M) code is also billed, payers look for a reason it should be paid on top. N626 says the payer decided it should not: the new or established patient E/M is not payable with the chiropractic care codes on this claim.

It usually appears with CARC 97 or 234, or CARC P14 on property and casualty claims.

Common causes

  • A routine visit code was added to every manipulation visit.
  • Modifier 25 was missing on an E/M that was truly separate.
  • Documentation didn’t show a distinct evaluation, such as a new complaint, a new injury, or a formal re-examination.
  • The payer’s fee schedule doesn’t allow an E/M with chiropractic care under any circumstances.

How to fix it

  1. Check the payer’s policy for E/M with chiropractic services.
  2. Review the note. Does it show a significant, separately identifiable evaluation beyond the usual pre-treatment assessment?
  3. If yes and the modifier was missing, submit a corrected claim with modifier 25 on the E/M line in box 24D and resubmission code 7 in box 22.
  4. If yes and the modifier was present, appeal with the documentation.
  5. If no, write off the E/M.

How to prevent it

Bill an E/M with chiropractic care only when a separate evaluation is documented, and apply modifier 25 consistently in those cases. For modifier and bundling background, see NCCI and bundling denials.

Codes that may appear with N626

  • CO-97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.): The benefit is included in the payment for another service already adjudicated.
  • CO-234 (This procedure is not paid separately.): This procedure is not paid separately.
  • CO-P14 (The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day.): Included in another service performed the same day, for property and casualty claims.
  • N20 (Service not payable with other service rendered on the same date.): Service not payable with another service on the same date.
  • N628 (Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.): Follow-up visits on the same day as a scheduled test or treatment are disallowed.
  • N666 (Only one evaluation and management code at this service level is covered during the course of care.): Only one E/M at this level is covered during the course of care.

N626 FAQ

Can a chiropractor ever bill an E/M with manipulation?

Many payers allow it when a significant, separately identifiable evaluation is documented, such as a new injury or re-evaluation, reported with modifier 25. Some payers, especially under certain fee schedules, limit or disallow it. Check the payer's policy.

Why isn't the routine evaluation paid separately?

Chiropractic manipulation codes generally include a pre-manipulation assessment, so a routine check before treatment is considered part of the service.

Is N626 used by group health plans?

It can be, but it is common on workers' comp and auto claims that follow state fee schedule rules.